Provider Demographics
NPI:1952570954
Name:OGWUMA, CLEMENTINA ADAKU (MSN, APRN-NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CLEMENTINA
Middle Name:ADAKU
Last Name:OGWUMA
Suffix:
Gender:F
Credentials:MSN, APRN-NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734875
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4875
Mailing Address - Country:US
Mailing Address - Phone:817-377-0143
Mailing Address - Fax:888-750-8159
Practice Address - Street 1:809 W HARWOOD RD STE 202
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-6233
Practice Address - Country:US
Practice Address - Phone:817-377-0143
Practice Address - Fax:888-750-8159
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716565163W00000X
TXAP13002363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP130022OtherBOARD OF NURSING